(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "United States Navy Medical News Letter Vol. 43 No. 6, 20 March 1964"

NavMed P-369 

:.v.-.v.-.v.w.vW-.w.-.l-. -f.::::::::- ■ ... 







&i&i3ftig^ffl 



1 * * — ■ •-■•■• ■ i i \'r '■•-••- -[V i V ii •;■ ■ •;• ■ ■••••■•■■■■-•• 

UNITED STATE S NAVY \ ■ • 



: Hi l 





^■^.•-•.•.v-v.--. -.■■■ •...•:• .. 



iiiii 



■•■•■•■•■■■■ •■ -- ■.•.■■•■•■'■ ■;■■ 



Vol. 43 



Friday, 20 March 1964 



No. 6 



TABLE OF CONTENTS 



MEDICAL ABSTRACTS 

Civil Defense Progress - 1963 ... 3 
Pan American Health 

Organization 5 

The Human Thermostat 10 

Cranial Measurements of Internal 

Temperature in Man 12 

Maximal Isometric Arm 

Exercises 13 



MISCELLANY 

American Board Certifications . 
Chromosome Studies in Adult 

Acute Leukemia 15 

Surgeons General of the Past ... 15 
Navy Mutual Aid Assn Reelects 

ADM McDonald President 17 

Psychiatry Teachers Study Uses 

of Television and Film 17 

Naval Medical Research Reports 18 

FROM THE NOTE BOOK 

Toward a More Useful Health 

Record 20 

MSC Training Announcement. ... 20 

Appointment of Navy Consultant 

for Optometry 21 

Innovation for the Blind at USNH 
Philadelphia 21 



FROM THE NOTE BOOK (Cont'd) 

Commendation for Jean Saylor of 
American Red Cross 21 

DENTAL SECTION 

Silicones and Soft Denture 

Bases 22 

Protectors to Reduce Dental 

Injuries 24 

Professional Notes 24 



14 OCCUPATIONAL MEDICINE 



Thermodecomposition of Epoxy 

Resins - Hazards from 27 

Preplacement Examinations in 
Industry Having Pulmonary 
Health Hazards 31 

Heat Protective Clothing - 

Requirements for 35 

Carbon Monoxide Hazard to 

Commercial Vehicle Drivers . . 36 

Human Anthrax 1953 - 1963 37 

RESERVE SECTION 



ACDUTRA Pay Speeded 38 

NC Officers on Inactive Duty 39 

Reservists Eligible for Tax 

Deductions 39 



United States Navy 
MEDICAL NEWS LETTER 



Vol. 43 Friday, 20 March 1964 No. 6 



Rear Admiral Edward C. Kenney MC USN 
Surgeon General 
Rear Admiral A. S. Chrisman MC USN 
Deputy Surgeon General 

Captain M. W. Arnold MC USN (Ret), Editor 

Contributing Editors 

Aviation Medicine Captain C. E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E, Rosenwinkel MC USN 

Preventive Medicine Captain J. W. Millar MC USN 

Radiation Medicine CDR J. H. Schulte MC USN 

Reserve Section Captain K. W. Schenck MC USNR 

Submarine Medicine CDR J. H. Schulte MC USN 



Policy 

The U. S. Navy Medical News Letter is basically an official Medical Depart- 
ment publication inviting the attention of officers of the Medical Department 
of the Regular Navy and Naval Reserve to timely up-to-date items of official 
and professional interest relative to medicine, dentistry, and allied sciences. 
The amount of information used is only that necessary to inform adequately 
officers of the Medical Department of the existence and source of such infor- 
mation. The items used are neither intended to be, nor are they, susceptible 
to use by any officer as a substitute for any item or article in its original 
form. All readers of the News Letter are urged to obtain the original of those 
items of particular interest to the individual. 

Change of Address 

Please forward changes of address for the News Letter to: Commanding Officer, 
U. S. Naval Medical School, National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new addresses. 



The issuance of this publication approved by the Secretary of the Navy on 
28 June 1961. 



Medical News Letter, Vol. 43, No. 6 3 

CIVIL DEFENSE PROGRESS IN 1963 

From "Introductory Highlights" of the 1963 Annual Report, Depart- 
ment of Defense, Office of Civil Defense. * 

Civil defense progress at the end of fiscal year 1963 was clearly evident on 
two distinct fronts: 

First, noteworthy success in surveying, marking, and stocking of 
public fallout shelters resulted in changing the character and quality of civil 
defense in the United States by ( 1 ) reorienting civil defense plans and pro- 
grams around the lifesaving potential offered by a nationwide fallout shelter 
system, and (2) identifying the least expensive methods of expanding this 
system. 

Second, the Armed Services Committee of the House of Representatives 
conducted an exhaustive study of certain facets of civil defense, particularly 
those concerning fallout shelters. This completely objective study was 
extraordinary in that it was based on the extensive testimony of 108 witnesses, 
most of whom possessed a special competence in some field related to fallout 
shelters. All arguments against the program had to be answered in unequivocal 
fashion, and the House was provided the information needed for it to develop 
and pass legislation designed eventually to extend the lifesaving potential of 
the nationwide fallout shelter system to every American. This legislation, 
H. R. 8200, was passed by the House, and was referred to the Armed Services 
Committee of the Senate on September 18, 1963. 

As described in the body of this report, the details of civil defense 
developments and accomplishments during the year show that a sound and 
substantial program has been formulated since major civil defense respon- 
sibilities were assigned to the Department of Defense 2 years ago. Basic 
elements of this program are operational and adequately based to support 
the action needed to make fallout protection available to everyone. 

Some major facts on development status of the nationwide fallout shel- 
ter system at the end of fiscal year 1963 were: 

1. Fallout shelter space for approximately 104 million persons had 
been located in existing structures. Of this amount, it is expected that 
shelter for 70 million persons can be marked, licensed, and stocked. 

2. Owners of more than 50, 000 facilities had signed shelter license 
agreements for use of space to protect more than 47 million persons. 

3. Shelter space to protect nearly 43 million persons had been marked 
in approximately 54, 000 facilities. 

4. Cumulative procurement had been initiated for shelter supplies 
sufficient to serve 50 million persons. 



The full report is for sale by the Superintendent of Documents, U. S. 
Government Printing Office, Washington, D. C. , 20402. Price 50£. 



4 Medical News Letter, Vol. 43, No. 6 

5. Shelters in approximately 21,000 facilities had been stocked with 
supplies to serve nearly 10 million persons. 

6. About 5000 county and municipal governments were active in local 
management and installation of shelter supplies. 

Other major developments during the year included: 

1. Establishment and implementation of civil defense functions as 
a mission of the Armed Forces to be performed prior to nuclear attack 
and during emergency conditions existing after attack. 

2. Further extension in use of Department of Defense resources for 
civil defense to include training of radiologic monitors by the U. S. Conti- 
nental Army Command and use of Standby Reserve officers in State and 
local civil defense work. 

3. Establishment of Regional Civil Defense Coordinating Boards to 
coordinate the civil defense planning of military departments and Federal 
agencies in the field with State and local governments. 

4. Use of approximately 15,000 Field Extension Service personnel of 
the Department of Agriculture in the rural civil defense program. 

5. Increased emphasis on shelter use training and radiologic defense 
training, including decontamination, by development of additional courses 
offered civil defense personnel at Office of Civil Defense schools. 

6. Expansion of training capability by initiation of a program for ex- 
tension divisions at 51 State institutions of higher learning to train instruc- 
tors in shelter management and radiologic monitoring and to conduct civil 
defense conferences with State and local officials. 

7. Training of approximately 788,000 persons in medical self-help 
technics, more than 2 78,000 in civil defense adult education, and 4255 key 
civil defense personnel and instructors at OCD schools. 

8. Strengthening of the data base for damage assessment in major 
resource areas; e.g. , food, fuel, and power, construction equipment, water, 
health, and manpower. 

9. Completion of plans for the Emergency Eroadcast System (EBS), 
established on August 5, 1963, to replace CONELRAD {Control of Electro- 
magnetic Radiations). The EBS will make approximately 1700 radio stations 
available to the President or his spokesman and to State and local govern- 
ments for the purpose of keeping the citizenry informed during civil defense 
emergencies. 

10. Work in progress on the National Emergency Alarm Repeater 
(NEAR) system, designed to give immediate indoor warning of impending 
attack. This included an analysis of 170 electric utility systems to deter- 
mine size and location of NEAR signal generators and the testing of NEAR 
prototype generating equipment in 7 electric utility systems. 

11. Activation of the Protective Structures Development Center at 
Fort Belvoir, Va. , in December 1962, to provide facilities supporting the 
development of improved design and construction of protective structures 
and related equipment. 



Medical News Letter, Vol. 43, No. 6 



THE PAN AMERICAN HEALTH ORGANIZATION 

Intergovernmental Health. Agency for the Americas 

THE PAN AMERICAN SANITARY BUREAU 

Secretariat of PAHO. PASB also serves as Regional Office 
of the World Health Organization for the Americas. 




Arcist's conception of the new PAHO headquarters building soon to be built at Virginia 
Avenue and 23rd Street, N. W., in downtown Washington, D. C, on land donated by the 
Government of the United States. 



WHAT IT IS 



The Pan American Sanitary Bureau (PASB), known as International Sanitary 
Bureau until 1923, had its origin in a resolution of the Second International 
Conference of American States (Mexico City, 1902) recommending that a 
"general convention of representatives of the health organizations of the dif- 
ferent American Republics" be convened. The convention met in Washington, 
D. C. in December 1902, and established the Bureau on a permanent basis. 



Medical News Letter, Vol. 43, No. 6 



[OW HUMAN ENERGY 



DARE SUBSISTENCE 




DEFICIENT NUTRITION 
MEAKR EDUCATION 
INADEQUATE HOUSING 



THE ECONOMIC CYCLE 
OF DISEASE 



Through the Pan American Health Organization, American na- 
tions help each other to better the health of their citizens, thus 
furthering economic development and raising social standards. 



The Pan American Sanitary Code (Havana), 1924), a treaty ratified by the 
Governments of the 21 American Republics, assigned the Bureau broader 
functions and duties as the central coordinating agency for international 
health activities in the Americas. The XII Pan American Sanitary Conference 
(Caracas, 1947) adopted a reorganization plan whereby the Bureau 'became 
the operating arm of the Pan American Sanitary Organization (PASO), the 
Constitution of which was officially approved by the Directing Council at its 
meeting in Buenos Aires later that year. At the XV Pan American Sanitary 

Conference (San Juan, P. R. 



GOVERNMENTS THROUGHOUT 
THE WORLD 



GOVERNMENTS OF THE 
AMERICAS 

m 



PAN AMERICAN' 
SANITARY I 
CONFERENCE 




DELEGATION 
KUtil. D0VHHKHT5 

■*Ss 



> REPRES*e8't«TIVE Finn EACH 
MEMBER GOVERNMENT 







REPHESCN1J11IUES FSOM SE«H n 
MEMBER GOVERHHENrS ELECTED 
BY. THE DIRECTIH.G COUNCIL 



THE 

PAN AMERICAN 

SANITARY BUREAU 

(USD REGIONAL OFFICE OT 

THE 
WORLD HEALTH 



SIX REGIONAL OFFICES 



21 September - 3 October 
1958), the name of the Pan 
American Sanitary Organ- 
ization was changed to Pan 
American Health Organiza- 
tion (PAHO). The Bureau's 
name remains unchanged. 

Pursuant to the agreement 
concluded between PAHO and 
the World Health Organiza- 
tion (WHO) in 1949, PASB 
serves as the WHO Regional 
Office for the Americas. 
PAHO is also recognized by 
the Council of the Organiza- 
tion of American States as 
an Inter-American Special- 
ized Organization with the 
fullest autonomy in the 
accomplishment of its pur- 
poses. 



Medical News Letter, Vol. 43, No. 6 



The Pan American Health Organization Comprises (Page 6): 

1. The Pan American Sanitary Conference, the supreme governing 
authority in which all Governments of the Organization are rep- 
resented, meets every four years and determines the general 
policies of the Organization, serves as a forum on public health 
matters, and elects the Director of the Bureau. 

2. The Directing Council, composed of one representative from each 
Government, meets once a year between Conferences, reviews 
and approves the annual program and budget of the Organization, 
and acts on behalf of the Conference. 

3. The Executive Committee, composed of representatives of seven 
Member Governments elected by the Council for overlapping 
terms of three years, meets twice a year to advise the Council 
on the activities of the Organization and carry out such other 
duties as the Council may assign to it. 

4. The Pan American Sanitary Bureau which is the operating arm 
of the Organization. 



The Director of the Pan 
American Sanitary Bureau 
is Dr. Abraham Horwitz of 
Chile, who began a four- 
year term of office on 1 Feb 
1959 and was reelected at 
the XVI Pan American San- 
itary Conference for a sec- 
ond term beginning 1 Feb 
1963. On 1 Jan 1962, the 
regular staff of the Bureau 
numbered 902, representing 
47 nationalities. Of this 
total, 666 were as signed to 
Zone Offices and field pro- 
jects and 236 were station- 
ed at the Washington Head- 
quarters. 

The fundamental pur- 
poses of PAHO are: To 
promote and coordinate 
efforts of the countries of 
the Western Hemisphere 
to combat disease, length- 
en life, and promote phys- 
ical and mental health of 
the people. 



INTERNATIONAL PROFESSIONAL PERSONNEL ASSIGNED TO HEALTH 
PROJECTS IN COUNTRIES OF THE AMERICAS, AUGUST 1962 




1 SCIENTIST 

I OTHER SPECIALIST 



Medical News Letter, Vol. 43, No. 6 



ASSIGNMENTS OF FIVE GROUPS OF PROFESSIONAL PERSONNEL 



AREA 


PHYSICIANS 


MffiSfS 


SANITATION 
PERSONNEL 


SCIENTISTS 


OTHER 
SPECIALISTS 


TOTAL 


106 


42 


114 


46 


109 


Wuhlmton 
Hdidquartsrs 


24 


3 


4 


3 


72 


Zona Olflew 


9 


6 


4 





10 


Projects la cwntrlts 


67 


31 


104 


17 


18 


Intercountiy PmjMtl 


3 


1 





10 


4 

_ 


SpMUl CwlWS 


3 


1 


2 


16 


s 1 



The Pan P. merican Health 
Organization is working to- 
gether with the countries of 
the Americas and with other 
international organizations 
to achieve the objectives of 
the Act of Bogota' (I960) and 
the Charter of Punta del 
Este (1961), The Bureau 
cooperates with the Govern- 
ments in the development 
and improvement of national 
and local public health ser- 
vices, provides consultant service, grants fellowships, organizes seminars 
and training courses, coordinates activities of neighboring countries having 
common public health problems, collects and distributes epidemiologic infor- 
mation and health statistics, and performs other related functions. 

HOW THE WORK IS CARRIED OUT 

At the Bureau Headquarters, the Director and his technical staff undertake 
the basic planning and coordination of activities. Advisory programs and 
services to the Governments are in five broad areas: 

1. Eradication and Control of Communicable Diseases 

2. Strengthening Health Services 

3. Environmental Sanitation 

4. Education and Training 

5. Research 

The eradication of malaria, smallpox, yaws, and the Aedes aegypti mosquito 
(vector of urban yellow fever) in the Western Hemisphere is well under way, 
as are programs for the control of other communicable diseases. To strengh- 
en health services, activities are directed toward the organization and improve 
ment of basic services, such as maternal and child health, nutrition programs, 
statistics, and other specialized fields at both the national and local levels. 
Within a broad environmental sanitation program, the planning, financing, and 
administration of water supply projects are assisted in all phases. Education 
and training activities are concerned with the basic professional education of 
physicians, nurses, sanitary engineers, and other health workers and are also 
included in integrated health service programs. Support is given to efforts of 
American countries to develop their full potential for biomedical research. 

The field activities of the Organization are administered from the six 
Zone Offices which maintain with the health authorities of the Governments the 
close relationship and consultation essential for planning and carrying out well 
balanced programs to meet health needs and problems at the national, inter - 
zone, and regional levels. 



Medical News Letter, Vol. 43, No. 6 



How the Work Is Financed 



ZONES AND 
ZONE OFFICES 



MEXICO, CI. F 



HID DE MNEIM 



The Pan American Health 
Organization derives the 
funds for its operation 
from several sources. The 
first main source of sup- 
port is the assessments 
on. the Governments of the 
Pan American Health Or- 
ganization. For the year 
1962, the assessments 
amounted to $5, 140,000 
(36% of the Organization's 
total budget of almost 
14.4 million dollars). An 
additional $100,000 for the 
regular budget comes from 
contributions of France, 
the Kingdom of the Nether- 
lands, and the United King- 
dom, and from miscella- 
neous income. 

In addition, voluntary 
funds for special purposes 
are contributed by Govern- 
ments and organizations in 
the Americas. The 1962 
budget provides for expen- 
ditures of more than five 
million dollars from these 
contributions. The larg- 
est is the Special Malaria Fund to which voluntary contributions have been 
made by Colombia, the Dominican Republic, Haiti, the United States of Amer- 
ica, and Venezuela. 

Moreover, as the Regional Office of the World Health Organization for 
the Americas, PASB will receive approximately $2,410,360 from the WHO 
regular budget in 1962, and $1,289,848 from Technical Assistance funds of 
the United Nations. The total estimated budget from all sources in 1962 
was $14,399,942. 

The United Nations Children's Fund (UNICEF) cooperates with PAHO/ 
WHO by providing supplies and equipment for health projects. Its participation 
in the health program in the last three years has averaged about $5,000,000 
per year for malaria eradication and over $1,000,000 per year for other health 
projects. 

(See Graph on page 10) 




HEADQUARTERS: WASHINGTON, D. C. 

I CARACAS 

II MEXICO, D. r.- 

III GUATEMALA 

IV LIMA 

V RIO DE JANEIRO 

VI BUENOS AIRES 



10 



Medical News Letter, Vol. 43, No. 6 



SOURCE OF FUNDS FOR 
PROGRAM OF THE PAN AMERICAN HEALTH ORGANIZATION, 1962 



U. S. DOLLARS 
2,000,000 4,000,000 



6,000,000 



T 



PAN AMERICAN 
HEALTH 



Regular Budget 




0AS-PTC 



WORLD HEALTH 



ORGANIZATION 



Regular Budget 



Wa 



m 



Technical Assistance Funds 



INCAP = Institute of Nutrition of Central America and Panama 

0AS-PTC = Program of Technical Cooperation of the Organization of American States 

CWSF = Special Community Water Supply Fund 

From: PAHO, brochure of the Pan American Health Organization, pub- 
lished by the Pan American Sanitary Bureau Regional Office of 
WHO. Misc. Publication No. 70, October 1962. 



THE HUMAN THERMOSTAT - SUMMARY 

Republished by permission of Reinhold Book Division of the Reinhold 
Publishing Corporation, 430 Park Ave. , New York, N. Y. , from 
Temperature - Its Management and Control in Science and Industry , 
Vol. 3, Part 3, Chapter 56, pages 662-663, a copyrighted (1963) 
publication of Reinhold. 

By T. H. Benzinger, C. Kitzinger 
Naval Medical Research Institute, Bethesda, Md. , 

and 

A. W. Pratt 

National Cancer Institute, Bethesda, Md. 

"Using cranial instead of rectal measurements of internal temperature and 
direct and continuous recording methods for the measurement of heat loss 
(by gradient layer calorimetry) and heat production (from oxygen consump- 
tion) the human mechanisms of temperature regulation in warm and in cold 
environments have been resolved in quantitative terms of reproducible stim- 
uli and responses. The mechanism of 'physi 03 - 1 - 1 temperature regulation was 



Medical News Letter, Vol. 43, No. 6 11 

found to consist of physiologically meaningful and reproducible sudomotor 
and vasomotor responses to warm stimulation of the internal thermorecep- 
tive system. No influence of warm reception at the skin upon sweating was 
detectable. (Diminution of sweating was observed, however, as a result of 
cooling the skin below the threshold of cold receptor responses.) On the other 
hand, the mechanism of 'chemical' heat regulation was found to consist of 
reproducible and meaningful responses to the stimulus of cold at the skin, 
counteracted by the reception of central temperature as it increases toward 
or beyond the set point for sweating. 

Together, the two mechanisms provide a thermostatic control of as- 
tonishing power and precision. These calorimetric findings are consistent 
with the discoveries of classical experimental surgery: (1) a 'center' from 
which heat loss responses originate (anteroir hypothalamus), extremely sen- 
sitive to the stimulus of temperature, (2) a heat maintenance center (posterior 
hypothalamus) indifferent to the stimulus of temperature, relaying cold-recep- 
tor impulses from the skin (for shivering and increased heat production), and 
(3) inhibition of shivering when warm stimulation is applied to, and release 
of shivering when warm stimulation is removed from, the (anterior hypothal- 
amic) 'heat loss center. ' 

Although the classical and the new experimental observations are not 
in contradiction anywhere, the classical conclusions and hypotheses need a 
thorough revision which will result in a much simpler concept. For both the 
anterior and posterior heat centers alike, classical theory had postulated 
(1) incoming sensory impulses from the skin, and (2) a peculiar power of re- 
sponding to warm or to cold by changing their response sensitivities to these 
incoming sensory impulses, warm or cold. 

The new experimental evidence does not support this complicated view. 
By calorimetry, the anterior center for warm was found not to receive warm- 
impulses from the skin. By neurosurgery (Hemingway), the posterior center 
for cold, which does receive and transmit cold-impulses from the skin, was 
found to be indifferent to temperature and, thus, was unable to modify affer- 
ent impulses with temperature. 

Thus, hypothetical synaptic mechanisms with special sensitivities for 
warm and cold in both centers are not supported by experimental facts. 
Instead, combined calorimetric and neurosurgical evidence lead to one ana- 
tomically established organ in the brainj in which all central sensory functions 
for temperature are vested. This organ, a warm-sensor in the anterior hypo- 
thalamus below the anterior commissure, appears to possess the essential 
characteristics. Its receptors have a sharply determined threshold or set- 
point. Their sensitivity to the faintest temperature changes is extraordinary. 
The organ is thus functionally, as well as by the developmental anatomy of 
its matrix, comparable to the retina, our terminal sensor for light. It may 
be called a 'temperature -eye. ' It exerts a tight control over the powerful 
responses in thermoregulatory heat production and heat loss. 

It is by way of these effector mechanisms that the 'Human Thermostat' 
performs its task. Quantitatively, the causes and effects, stimuli, and re- 
sponses in the system of human temperature regulation are no longer unknown. 



12 Medical News Letter, Vol. 43, No. 6 

The work reported here was supported under Research Contract 
#R-8 and R-38 by the National Aeronautics and Space Administration. " 



CRANIAL MEASUREMENTS OF INTERNAL 
TEMPERATURE IN MAN 

Republished from Temperature - Its Measurement and Control in 
Science and Industry , Vol. 3, Part 3, Chapter 10, page 120, Copy- 
right 1963 - by permission of Reinhold Book Division of the Reinhold 
Publishing Corporation, 430 Park Ave. , New York, N. Y. 

T.H. Benzinger 

Naval Medical Research Institute 

and 

G. W. Taylor 

Naval Hospital, National Naval Medical Center, 

Bethesda, Maryland 

"Cranial measurements of internal body temperature on man were introduced 
to replace the rectal measurement in studies of the physiologic mechanisms 
of temperature control. Although taken in places of different location, circu- 
latory requirements and metabolic characteristics, cranial (including tym- 
panic) measurements showed consistent patterns during applications of exter- 
nal or internal stress of warm or cold. Under the same conditions, rectal 
measurements deviated widely from cranial observations. Furthermore, it 
was not possible with rectal measurements to establish reproducible relations 
between thermal stimuli and thermoregulatory responses. Cranial measure- 
ments of internal temperature were found to be reproducibly and quantitatively 
related to thermoregulatory responses in heat or cold. The brush-type tym- 
panic thermocouple is introduced. This probe holds itself to the eardrum with 
minimum discomfort for indefinite periods in cranial clinical thermometry. " 

ADDENDUM prepared for the U.S. Navy Medical News Letter by Dr. Benzinger: 

It is, therefore, expected that the method will replace the rectal and esopha- 
geal measurements of body temperature in the future, not only in operating, 
emergency, and recovery rooms, but also on patients -wards, in doctors 1 of- 
fices and in homes. For these applications the technical development of a read- 
ing-instrument for the electrical potential from the thermocouple is, of course, 
a necessary presupposition. The main advantages of the method will be: (1) 
Reading of undistorted patterns of temperature near the central nervous sys- 
tem, not in the rectum where there are no thermoreceptors or centers of the 
thermoregulatory system; (2) Immediate and convenient reading while probe 
is in place; (3) Cleanliness of the procedure as it will avoid the rectum and will 
apply a new cheap and disposable probe for each individual reading or record- 
ing- (4) Derivation of the measurement from the head, the convenient location 
for'the anesthesiologist; (5) No interference with airways as in esophageal 
thermometry during anesthesia. 



Medical News Letter, Vol. 43, No. 6 13 



Injurious Consequences of Maximal 
Isometric Arm Exercis es 

By Major George E. Ottot, U.S. Marine Corps, Physical 

Fitness Coordinator. 

Ref: (a) U.S. Navy Medical News Letter, Vol. 42, No. 11, page 13 

Reference (a) includes an article regarding Injurious Consequences of Max- 
imal Isometric Arm Exercises. The article summarizes a study performed 
by Philip J. RaschPhD, of the Naval Medical Field Research Laboratory, 
Camp Lejeune, N. C. 

From the results of the study, it was reported that eleven of fifteen 
subjects tested developed severe muscle pains after performing maximal 
isometric contractions of the forearm flexors. The subjects performed max- 
imum isometric contractions throughout the program against the static 
resistance of a stationary bar. The article reads: "Normally, when an 
individual flexes the forearm against an immovable bar, the wrists drop into 
a position of hyperextension in an attempt to relieve stress created in the 
wrist flexors as the powerful elbow flexors seek to produce a concentric 
contraction of the forearms. In this investigation, subjects were required to 
maintain the wrists in line with the forearms in order to insure that contrac- 
tion was as fully isometric as was mechanically possible. Presumably the 
resulting strain on the wrist flexors became intolerable and resulted in 
physical damage to some of the weaker fibers. " 

The subject article includes a reference to the Navy-Marine Corps 
exercise pamphlet SHAPE-UP. It should be noted that SHAPE-UP instructions 
for executing isometric exercises clearly specify that only 50% of maximum 
pressure should be applied during the first week of such exercises. This in- 
struction was included for the express purpose of diminishing any possibility 
of muscular strain as a result of performing maximal isometric contractions. 
Additionally, SHAPE-UP illustrates forearm flexor exercise being performed 
in a manner which would cause the wrists to drop into a position of hyperexten- 
sion, thereby tending to relieve stress on the wrist flexors and to eliminate 
any muscular strain. 

A 10-week evaluation was recently completed by the Marine Corps 
involving fifteen subjects who executed maximum isometric exercises of the 
forearm flexors against a bar in exactly the manner described by Rasch. 
During this 10 -week period, there was not one instance of injury as described 
by Rasch, nor was any other area of the body so affected. 

The subject article ends with the statement: "Results of this study 
suggest precaution in prescribing maximal biometric forearm flexion exercise 
for healthy adult males. " The Marine Corps concurs in this and has, in fact, 
developed isometric exercise programs within the framework of adequate 
precautionary measures. 

The above information is offered to allay any misgivings concerning 
the use of isometric exercises as described in SHAPE-UP and other official 



14 



Medical News Letter, Vol. 43, No. 6 



isometric exercise publications issued by the Navy and Marine Corps and 
currently being used to improve physical fitness. 

It is recommended that the substance of the foregoing be promulgated 
in an early Medical News Letter in order to prevent possible misconceptions 
and misinterpretations which might prove damaging to effective, carefully 
developed fitness programs. 

/s/ George E. Ottot, Major USMC 
Physical Fitness Coordinator 

NOTE: As a matter of interest, Major Ottot sent a copy of the above article 
to Doctor Rasch for his comments. He repliedthat he had no criticism 
of the article and, in fact, was in agreement with it. It is believed 
that Major Ottot has rendered a valuable service in proving the safety 
of the official Isometric Exercise Programs of the U. S. Navy and 
Marine Corps, as well as demonstrating the complete reliability of 
the official isometric exercise publications including SHAPE-UP which 
are important in the operation of an ever improving physical fitness 
program throughout the Navy and Marine Corps. It is gratifying to 
rece { ve articles of this type which assist readers in the correct inter- 
pretation of potentially questionable issues. Our congratulations to 
Major Ottot and to Doctor Rasch. 

— Editor 




MISCELLANY 



American Board Certifications 

American Board of Dermatology 

LCDR Enrique M. deArrigoitia MC USN 

American Board of Pediatrics 

LCDR Robert K. Norton MC USN 

LT Lawrence A. Caliguiri MC USNR (Active Duty) 

American Board of Plastic Surgery 

LCDR Mario A. Vasquez MC USN 



American Board of Radiology 

CDR John H. Ebersole MC USN 



Medical News Letter, Vol. 43, No. 6 

American Board of Radiology (Continued) 

LCDR Fredrick Y. Durrance Jr, MC USN 

LT James R. Brown MC USN 

LT Charles M. Klein MC USNR (Active Duty) 

American Board of Surgery 

LCDR James L. Glass MC USN 
LCDR Jack A. Langevin MC USN 
LCDR Clinton H. Lowery MC USN 

* * * * * * 
Chromosome St udies in Adult Acute Leukemia 

Unrt r^Vt ld 'i A " gelaAdams ' andF.W. GunzBECC. Cytogenetics 
Sat ^S -llT, l h 9 64 OSPlta1, ChrtStChurch ' NeW Z ~^ J Nat Cancer 

Chromosome studies of 18 adults with acute leukemia are reported. Blood 

made tt / " ^ dl " Ct examinati °- of the bone marrow were 

s^sted of both mOS °T ab ™ rmalities ^re unique in each patient and con- 
sisted of both numerical and structural changes; they could not be correlated 
wxth any cUnxcal or hematologic features. When the marrow was examined 
-Peatedly ^individual patients, the abnormalities persisted regardless of 
the stage of the disease, though some diminution in their number occurred 
during remissions. The findings suggest that the chromosome abnormalities 
are intimately associated with, and perhaps an essential part of, the develop- 
ment of acute leukemia. ueveiop- 

* * * >:< 5ls ;[: 

Surgeons General of the Past 

By E.P. Kuhn JOl USN 

The 19th Chief of the Bureau of Medicine and Surgery and 15th Surgeon 
General of the Navy, William C. Braisted MD, was born in Toledo, Ohio 
on 9 October 1864. In 1883, he received the Bachelor of Pharmacy degree 
from the University of Michigan and, in 1886, was awarded the degree of 
Doctor of Medicine, graduating as honor man in his class from the College 
of Physicians and Surgeons, Columbia University in New York City After 
interning at Bellevue Hospital in New York, he practiced medicine in Detroit 
from 1888 to 1890. During that period he served as assistant Neurologist at 
Harper s Hospital, visiting physician to Women's Hospital, and attending 
surgeon at Jenks Sanitarium for Women. 

On September 24, 1890, Doctor Braisted was appointed as Assistant 
Surgeon in the U. S. Navy with the rank of Lieutenant (junior grade). He was 



15 



16 Medical News Letter, Vol. 43, No. 6 

decorated with the Order of Bolivar by the President of Venezuela for his 
bravery in caring for the wounded during the battle of Puerto Cabello. Also, 
he earned the Spanish Campaign Medal. Later on, his report of the medical 
organization and work of the Japanese during the Russo-Japanese War won 
him a decoration by the Emperor of Japan. 

Through successive promotions, Doctor Braisted advanced to the rank 
of Captain in the Medical Corps. He was appointed Assistant to the Chief of 
the Bureau of Medicine and Surgery in 1906 and during that tour of duty had 
charge of reorganizing the Bureau. He was instrumental in initiating the 
U.S. Naval Medical Bulletin, the first issue of which was published in April 
of 1907 during Surgeon General Rixey's administration. For a year, during 
the second term of President Theodore Roosevelt, he served as Attending 
Physician at the White House. He also helped in reorganization of the Hospital 
Corps and establishment of the Navy Nurse Corps in May 1908. 

In February 1914, Doctor Braisted was appointed Surgeon General and 
Chief of the Bureau of Medicine and Surgery with the rank of Rear Admiral in 
the Medical Corps. He assumed the initiative in the construction and admin- 
istration of the most modern naval hospitals, and in the establishment of 
special training schools for the Hospital Corps. Under Admiral Braisted, 
the first hospital ship of the Navy was designed and fitted out from the keel 
up to meet definitive patient care requirements of the United States Fleet. 
Launched at the Philadelphia Navy Yard in December 1920, it was christened 

the USS RELIEF. 

Admiral Braisted assisted in abolition of wine messes in the Navy. 
He founded the Handy Book for the Hospital Corps, U. S. Navy (later termed 
Handbook), the Manual of the Medical Department for Medical Department 
Officers, and a supplement to the U.S. Naval Medical Bulletin entitled 
Hospital Corps Quarterly for the continuing training of Hospital Corpsman. 

When World War I erupted, Admiral Braisted responded with tireless 
energy. An outstanding administrator, he promptly implemented efficient 
plans and rapidly expanded all aspects of Navy Medical Department support 
in the total war effort. Additionally, he was Vice Chairman of the War Relief 
Board of the American Red Cross and a member of its executive and central 
committees, and was a member of the Council of National Defense and the 
General Medical Board in 1917. For his war service he was awarded the 
Distinguished Service Medal which carried the citation "For exceptionally 
meritorious service in a duty of great responsibility as Chief of the Bureau 
of Medicine and Surgery. " He also earned the World War I Victory Medal. 

Admiral Braisted was serving his second term as Surgeon General at 
the time of his transfer to the retired list on 29 November 1920. He made 
his home in West Chester, Penna. , where he lived until the time of his death, 
17 January 1941. Interment was in Arlington National Cemetery. 

- >- J. vi> »l» J> »A» 
>fi >fi *JC 9JG t -■,» 



Medical News Letter, Vol. 43, No. 6 17 

Admiral McDonald Reelected President 

of 
Navy Mutual Aid Association 

The Board of Directors of the Navy Mutual Aid Association at their Annual 
Meeting on 20 February 1964 announced the reelection of Admiral David L. 
McDonald USN as President. Other officers elected by the membership were 
Rear Admiral A.H. Van Keuren USN RET ; First Vice President;Vice Admiral 
V. R. Murphy USN RET, Second Vice President ;Lieutenant General C. H. Hayes 
USMC, Third Vice President; Vice Admiral K. K. Cowart USCG RET, Fourth 
Vice President; and Captain P. R. Engle MC USN, Vice President -Medical 
Director. Elected to the Board of Directors were: 

RADM L. A. Bachman USN RET RADM J. B. Heffernan USN RET 

RADM J. W. Bottoms SC USN RADM A. S. Heyward Jr, USN 

ADM Arleigh Burke USN RET RADM R. L. Moore Jr, USN 

RADM P. Corradi CEC USN CAPT G. D. O'Brien USNR 

RADM J. W. Crumpacker SC USN JLCDR J. F. O'Neil USN 

RADM W. E. Ellis USN BRIGEN R. R. Van Stockum USMC 
RADM E. B. Fluckey USN 

The Board of Directors reappointed Captain T.S. Dukeshire SC USN RET, as 
Secretary and Treasurer, and Lieutenant Commander M. E. Koepke MSC USN 
RET Assistant Secretary and Treasurer. Vice Admiral V. R. Murphy USN 
RET was continued in office as Chairman of the Finance Committee; Vice 
Admiral K. K. Cowart, USCG RET as Chairman of the Membership Committee; 
and Rear Admiral L. A, Bachman USN RET, Chairman of By-Laws Committee*. 

The Chase Manhattan Bank of New York was continued as investment 
counsel for the Association and the Morgan Guaranty Trust Company of New 
York retains custody of the Association's securities. The actuarial firm of 
Bowles, Andrews & Towne of Richmond, Va. , will continue to serve as the 
Association's actuarial advisor. Captain Dukeshire reported that in 1963 
the goal of 40, 000 members was passed and that the Association's assets were 
increased by 12% to more than $68,000,000. 

****** 

Psychiatry Teachers Study Uses 
of Television and Film 

Sixty representatives of medical school departments of psychiatry in the 
southern region of the United States and the Washington, D. C. , area partici- 
pated in a Conference on the Uses of Television and Film in Teaching Psy- 
chiatry at the National Naval Medical Center, Bethesda, Md. , on 22 and 23 
January 1964. Dr. Lawrence Kolb, Director of New York Psychiatric Insti- 
tute, delivered the keynote address. Demonstrations of videotapes and films 
useful for various kinds of instructional purposes in psychiatry were given by 



18 Medical News Letter, Vol. 43, No. 6 

Drs. L. C. Hanes, University of Mississippi Medical Center ; Richard Meiller, 
Medical College of Virginia; William Cantrell, Baylor University College of 
Medicine; J. Earl Somers, University of North Carolina School of Medicine; 
Lou Woodward Marshall, Medical College of Georgia; and Floy J. Moore, 
University of Mississippi Medical Center. 

A panel on Administrative and Technical Aspects of Film and Tele- 
vision in Psychiatry included presentations and discussion by Dr. Floyd 
Cornelison, Chairman, Department of Psychiatry, Jefferson Medical College; 
CDR Edward Bird, Television Project Officer, Bureau of Medicine and Sur- 
gery, Navy Department; and Mr. M. C. Shaffer, Director, Visual Education 
Department, Medical College of Virginia. 

General sessions were chaired by Dr. Charles Watkins, Head, Depart- 
ment of Psychiatry and Neurology, Louisiana State University School of Med- 
icine; Dr. William G. Reese, Head, Department of Psychiatry, University of 
Arkansas Medical Center; and Dr. William K. Keller, Acting Chairman, 
Department of Psychiatry, University of Louisville. 

Participants discussed instructional and technical aspects with resource 
personnel and recommended interinstitutional projects for cooperative pro- 
duction of recorded materials for the psychiatric instruction of undergraduate 
medical students, residents in psychiatry, and general practitioners. 

The program was presented by the Southern Regional Education Board 
with cooperation of the National Naval Medical Center. 

— From Educational Television Bulletin, Southern Regional 
Education Board, 130 Sixth St. , N. W. , Atlanta 13, Ga. 

****** 
Naval Medical Research Reports 

U. S. Naval Medical Research Institute, National Naval Medical Center , 

Bethesda, Md . 

1. Animal Calorimetry: Its Furue R 005. 03-0050. 02 Report No. 8, 

June 1962. 

2. Plasmodium Lemuris N. SP. from Lemur Collaris E. Geoffroy: 
MR 005.09-1030. 02 Report No. 8, May 1963. 

3. Lipid Glyceride Synthesis by Rat Skeletal Muscle: MR 005. 12-1100. 02 
Report No. 16, May 1963. 

U.S. Naval Medical Research Unit No. 3, Malakal Sub- Unit, Cairo, Egypt 

1. Preliminary Findings of Surveys for Brucella Antibodies in Ethiopia and 
Central Sudan: MR 005. 09-1 150, January 1964. 

2. Serum Protein Electrophoresis in Sudanese Kala-Azar with Two Case 
Histories: MR 005. 09-1603. 7, January 1964. 

U. 5. Naval Medical Field Research Laboratory, Camp Lejeune, N. C . 
1. A Five-Year Research Program. Camp Leieune - Parris Island 
Studies, 1959 - 1964. 



Medical News Letter, Vol. 43, No. 6 19 

U.S. Naval Medical Research Laboratory, U.S. Naval Submarine Base , 
New London, Conn . 

1. Ultraviolet Air Sterilization for Polaris Submarines: 
MR 005. 14-3002-4.09 Report No. 408, August 1963. 

U. S. Naval Hospital, Oakland 14, Calif. , Clinical Investigation Center . 
1. Biochemical Basis of Glomerular Dysfunction: MR 005. 12-1608, 1963. 

U.S. Naval School of Aviation Medicine, Naval Aviation Medical Center , 
Pens a cola, Fla . ~" ~ ~ 

1. Perception of the Postural Vertical Following Prolonged Bodily Tilt in 
Normals and Subjects with Vestibular Defects: MR 005. 13-6001 
Subtask 1 Report No. 81, June 1963. 

2. The Prognostic Value of the Cold Pressor Test and the Basal Blood 
Pressure Based on an Eighteen-Year Follow-up Study: MR 005. 13-3001 
Subtask 2 Report No. 6, July 1963. 

3. A Longitudinal Study of Healthy Young Men - Correlation Coefficients: 
MR 005. 13-3001 Subtask 2 Report No. 7, July 1963. 

4. Ballistocardiographic Analysis Utilizing Mathematical Model and Photo- 
electric Analog: MR 005. 13-7004 Subtask 6 Report No. 10, July 1963. 

5. Proposed Speech Discrimination Test for Senior Naval Aviators: 
MR 005. 13-3001 Subtask 9 Report No. 1, August 1963. 

6. Incidence of Physiological Symptoms in Healthy Men After Exposure to 
Rapid Decompression to 43, 000 Feet Simulated Altitude: 

MR 005. 13-1002 Subtask 9 Report No. 3, September 1963. 

7. Determination of Fire Hazard in a Five PSIA Oxygen Atmosphere: 
MR 005. 13-1002 Subtask 11 Report No." 4, September 1963. 

8. Effect of Vibration and Restraint on Body Weight and Survival of the 
Albino Rat: MR 005. 13- 1002 Subtask 17 Report No. 5, September 1963. 

9. Predicting Success in Aviation Training: MR 005. 13-3003 Subtask 10 
Report No. 7, September 1963. 

10. Exploratory Investigation of the Relationship Between Four Personality 
Measures and Voluntary Resignation from Aviation Training: 
MR 005. 13-5001 Subtask 1 Report No. 25, September 1963. 

U. S. Naval Medical Research Unit No. 2, Taipei, Taiwa n. 

1. Preliminary Experiments on Effects of Chemical Histamine-Liberators, 
Local Edema, and "Wind Vegetables" of Taiwan on the Mast Cells of the 
Rat: MR 005.09-1901. 1.4, May 1963. 

2. Summaries of Research, January - June 1963. 

3. Intestinal Morphology in Human and Experimental Cholera: 
MR 005.09-1040. I. 12, July 1963. 

4. Epidemiology of Japanese Encephalitis Virus on Taiwan in 1961: 
MR 005.09-1201. 2. 9, July 1963. 

5. Intestinal Parasites of Man in Palawan, Republic of the Philippines: 
MR 005.09-1601. 1.2, July 1963. 



20 Medical News Letter, Vol. 43, No. 6 

FROM THE NOTE BOOK 

Toward a More Useful Health Record . Page Change 14, Manual of the Medical 
Department, contains modifications to Article 16-12, 16-48, 16-66, and 16-69 
tending toward a more complete record of medical history in each member's 
current Health Record. 

The purpose: to afford the attending physician needed information 
concerning previous illnesses and special examinations without reference to 
medical records maintained in BuMed. Under the new procedures, the origi- 
nal of the Narrative Summary (SF 502) covering periods of inpatient hospital- 
ization plus the reports of baseline electrocardiograms and baseline audio- 
grams are to be permanently retained in each member's current health record 
throughout periods of active duty. As in the past, a copy of the 3F 502 will be 
placed in the hospital clinical record of the member concerned. For officers, 
the original plus one copy of the SF 502 will be placed in the Health Record. 
The copy will be retired to BuMed along with the Standard Form 600 and other 
medical records following completion of the annual physical examination or, 
if the officer is exempt from an annual physical examination, at the end of the 

calendar year. 

It must be emphasized that, even though the SF 502 is now retained in 
the member's current Health Record, certain entries are still required on the 
Standard Form 600 (Chronological Record of Medical Care). These required 
entries show activity, date of admission, diagnoses, and diagnostic number 
for which treated, line of duty and misconduct determination, and the method 

and date of disposition. 

—From Physical Qualifications and Medical Records Division, BuMed 

# * % s!s * * 

I mportant MSC Training Announcement 

Commencing with the 1964-1965 academic year (Class 26) at the Naval 
School of Hospital Administration, National Naval Medical Center, 
Bethesda, Md. , convening in August 1964, the coarse in English Com- 
position offered will be ENGLISH 2; therefore, the basic introductory 
course in English Composition, usually titled ENGLISH COMPOSITION 
1, is a highly desirable prerequisite. English Composition 1 can be 
completed by enrolling for the course at an accredited college or uni- 
versity, or by completing the USAFI correspondence course ENGLISH 
COMPOSITION 1 (Course number CC-400 or CD. 400). MSC officers 
who anticipate attending NSHA at some future date should complete the 
English 1 requirement at the earliest practicable date and forward the 
results thereof to the Bureau of Medicine and Surgery, Code 35. 

— MSC Division, BuMed 

s ;c * # # # * 



Medical News Letter, Vol. 43, No. 6 21 

Appointment of Navy Consultant for Optometry . The Surgeon General, Rear 
Admiral E. C. Kenney MC USN, has appointed Doctor William Greenspon as 
Civilian Consultant in Optometry in the Navy. Doctor Greenspon has held 
many posts moptometric organizations, thus contributing much to the profes- 
sion of Optometry. He is a graduate of the Philadelphia College of Optometry 
and a Fellow of the Academy of Optometry. In 1962, he received an honorary 
degree of Doctor of Ocular Science from the Illinois College of Optometry 
and is Director of the American Optometric Association's Department of 
National Affairs. 

Workable Innov ation for the Blind at USNH Philadelphia . Under the direction 

n™» S!T7iT ia ° fflCe f ° r the BUnd ' a Snack bar has been opened at the 
USNH Philadelphia. Sponsored by this organization, blind persons are trained 
for this work and equipment is provided; the operator furnishes merchandise 
at his own expense. Usually, a sighted person oversees the operation A 
small percentage of profit goes to the Pennsylvania Office for the Blind for 
maintenance of equipment and development of the program. The operator 
receives the balance of profit. More than 140 snack bars of this type have 
been opened in Pennsylvania since 1952. This is the first to be set up in a 
Naval Hospital. r 

Commanding Officer, Wal t er Reed Army Medical Center, Commends M iss 
Saylor of A. R. C. Miss Jean Saylor, Recreation Supervisor, American Red 
Cross, who recently reported for duty at the U.S. Naval Hospital in Phila- 
delphia, received a Certificate of Achievement for outstanding services ren- 
dered while assigned to the Walter Reed Army Medical Center-her last duty 
station. The following certificate from Major General A. L. Tynes MC USA 
Commanding Officer of the Medical Center, was presented to Miss Saylor by 
Captain J. A. Syslo MC USN, Commanding Officer of USNH Philadelphia. 

"Miss Saylor planned, organized, and administered the recreation 
program at the Walter Reed Army Medical Center in a superlative manner 
combining her training and experience with an exemplary ability to express 
herself orally and in writing. She was responsible -for much of the develop- 
ment, supervision, coordination, and interpretation of medically approved 
recreation for patients, and had the overall responsibility for the training 
of the recreation staff. Her awareness of public relations helped develop 
community contacts, furthering the good will between the Center and the 
civilian community. Throughout her service she displayed a thorough 
knoweldge and understanding of the hospital, its patients, and their illnesses 
and injuries as related to recreation. These attributes reflect credit upon 
Miss Saylor as an individual and upon the American Red Cross. " 

Miss Saylor holds a B. S. degree in Education and Social Studies 
Since entering the American Red Cross as a Recreation Worker at Fort 
McClellan, Alabama, in 1943, she has served widely, including foreign service 
in Germany, France, Korea, and Japan. 



-j* T- ^ 



22 Medical News Letter, Vol. 43, No. 6 




DENTAL I ^WIj H SECTION 



Prope r ties and. Procedures of Silicones 
fo r Soft Denture Bases 

J. Den. Res. 43(1):118-120, January-February 1964. George W t 
Barnhart, Zoller Memorial Dental Clinic, University of Chicago, 
Chicago, Illinois. 

In making a brief reference to soft relining resins, Paffenbarger and Bowen 
have indicated that a more extensive use would be made of them as the resins 
improved in quality. Clinical results employing silicones as denture -cushion- 
ing materials in a variety of intraoral situations have been reported. 

It is important to note that not all silicone rubbers are suited for use 
as a denture -base substance and that the toxicity, strength, durability, plus 
ease of handling are features to be considered. McGregor in writing on toxi- 
cologic studies of silicone materials of many types, has stated that silicone 
rubbers have a low order of toxicity and that their toxicologic properties 
depend, not on the base polymer, but on the fillers and additives used. He 
further stated thatnumerous feeding experiments with rats, rabbits, and dogs 
have shown no interference with metabolic functions and that normal growth 
rates have been maintained. Intradermal, subcutaneous, or intramuscular 
injections did not cause any inflammation or other discernible disorder. 

Special medical-grade silicone stocks are available that are extremely 
low in toxicity. They have been used to produce tubing and prosthetic heart 
valves for permanent implants in both animals and humans. Only those st ° cks 
free of toxic agents, which have been proved physiologically inert, should be 
selected for special medical and dental uses. 

Medical Silastic 372, Dow Corning Corporation, silicone was selected 
because of its ability to fill the specific needs of a soft-denture-base material. 
These needs include: compatability with oral tissues and denture-base ma- 
terials, lack of taste (once cured), dimensional and chemical stability, long- 
term retention of softness or resilience, and theneedfor amatenal that does 
not support bacterial growth, and thus precludes fouling. 

The adhesive Experimental Soft Denture -Base Material Q-9-0123, Dow 
Corning Corporation, is a specialized silicone originally developed as a med- 
ical-grade adhesive for adhering silicone rubber to itself as well as to many 
other materials. It is a soft paste that can be easily spread with a spatula, 
and there are no solvents present. It has been found to lend itself to present- 
day dental techniques, and alone it serves very well as a soft-denture -base 
material. 



Medical News Letter, Vol. 43, No. 6 23 

The adhesive material may be used as the denture liner in the follow- 
ing manner; 

1. The wax-model denture is constructed in the conventional manner, in- 
vested in the processing flask, wax boiled out, and a liquid-foil separating 
agent is painted onto the stone-mold surfaces of the flask half containing the 
teeth. 

2. Prior to packing the acrylic plastic into the mold, the desired thickness 
of the eventual silicone denture liner is formed on the stone model in its half 
of the processing flask, using dental-base-plate wax. This wax spacer is 
formed just short of the full extent of the denture's periphery. By forming 
the wax spacer in this manner, the resultant denture will contain a soft liner 
extending down to the deepest portion of the periphery, while the acrylic-plastic 
portion is finished and polished so as to roll up and away from the junction of 
the two materials. 

3. The acrylic plastic is packed into the mold cavity with a sheet of sepa- 
rating plastic between the model half of the flask, containing the wax shim, 
and the mold half. With the mold half loaded with the acrylic plastic, follow- 
ing two or more trial packings to insure a completely filled mold, the flask 
is parted. 

4. At this point the uncured acrylic is painted with the (RTV) primer, which 
is then allowed to dry for a fifteen -minute period. 

5. During the primer drying time the wax shim is removed, and the model 
and the land area of the lower half of the flask are painted with a separating 
medium of a 10 per cent solution of detergent and water. 

6. The silicone adhesive soft denture lining material is expressed from 
its tube onto the primed acrylic surface in such a manner as to preclude the 
formation of voids and to a slight overloading of the space created by the wax 
shim. 

7. With the mold space filled to slight excess, the flask is closed together 
until there is metal to metal contact, and the flask is placed in its processing 
press or clamp and introduced into a water bath. The bath temperature is 
elevated to 165° F. where it remains for an overnight cure period. The sili- 
cone material vulcanizes as the acrylic plastic cures, and the bond between 
the two materials is most satisfactory. 

8. Following the processing, the denture is recovered, and the finishing 
of the periphery may be accomplished by using a dental arbor band to trim 
away any flash material. The final finishing of the soft material at the junc- 
tion line may be achieved by using either a small, sharp scissors or surgical 
blade. Conventional methods are used to polish the acrylic-resin portion of 
the denture. 

A new and simple technique is presented for the use of silicone mate- 
rials as a soft-denture-base liner that provides greater flexibility in select- 
ing a material and technique that can best be adapted to each intraoral situa- 
tion requiring the use of soft materials. 

The heat -vulcanized material was found to be most valuable where 
greater strength is needed, such as in obturated cases. However, the RTV 



24 Medical News Letter, Vol. 43, No. 6 

adhesive material was not only considered valuable in a heat-curing technique, 
which provided liners for new acrylic-resin dentures, but equally valuable in 
the room-temperature-vulcanizing method, in which an existing denture can 
be relined with a soft base. 

****** 

Mouth Protectors Reduce Dental Injuries 

The role that mouth protectors play in reducing dental injuries becomes more 
prominent each year. Football players have been required since 962 by the 
National Alliance Football Rules Committee, to wear the intraoral mouth pro- 

teCt ° rS Throughout the Navy, emphasis has been placed on the use of mouth- 
guards in all contact sports. Particularly remarkable is the record at the 
U S. Naval Academy, Annapolis, Maryland. During the past year, only one 

denfal injury was reported in the entire brigade of over 3, 800 midshipmen, 
dental injury ^ P.^ ^ ^ ^ ^ ^ ^ High ^ x ^hl .tic 

Plan, Incorporated, showed a 53% reduction between the 1952-58 and 1962-63 
school y«£ fche reductiQn to almost zero injuri es at the Naval Academy, 
in contrast to the 53% reduction in the New York study, can be attributed to 
the emphasis on the need to wear the custom-made protectors during practice 
sessions as well as in schedule competition. 

In addition to the emphasis on when to wear the mouthguard, two other 
factors are contributing to the successful reduction of injuries One, the 
mouthpieces are carefully fitted for each individual. This ' »^» ^"^ 
comfortable and thus more acceptable. The other, when the mouthguards are 
delivered, directions are included for proper care and cleaning, and a plas- 
tic perforated container is provided. 

The low costs of the material and equipment and the short time re- 
quired by the dental officer and technician combine to make this highly effec- 
tive procedure a must for all involved in contact sports. 

r Dental Division, BuMed 



* 



Personnel and Professional Notes 



P articipation During National Childr en's Dental Health Week Many Navy 
dental activities have reported an active participation during National Chil- 
dren s Dental Health Week, February 2 to 8. Typical of actions taken were 
those of five dental officers from the Submarine Base at New ^«^ Groto11 ' 
Connecticut. LCDR Joseph I. Tenca and Lieutenants John P Williams 
David H. Monahan, Robert W. Corsello and Sam Poidmore delivered talks 
to children of the elementary schools in the New London area. They empha- 



Medical News Letter, Vol. 43, No. 6 25 

sized the importance of nutrition and proper oral hygiene in the preservation 
of dental health. 

Navy Dentist Presents Talk Before Research Group . CAPT Fred L. Losee, 
DC, USN, U. S. Naval Training Center, Great Lakes, 111., presented a talk 
entitled, "Soils, Minerals and Health, " before the Naval Reserve Research 
Group 9-1, on 11 February 1964, at Navy Pier, Chicago, Illinois. 

Capt Losee, will also be on the TV program, "Science Unlimited. " 
He will appear as Professor Mariella's guest, discussing research. The pro- 
gram will be shown in Chicago, New York, and Los Angeles, at different times 
in the latter part of May. Capt Losee will discuss the results of studies in 
New Zealand, and some of the studies underway at Great Lakes. 

Presentation At Greater New York Dental Meeting . CAPT Roger G. Gerry, 
DC, USN, Chief of Dental Service at U, S, Naval Hospital, St. Albans, New 
York, and Diplomate, American Board of Oral Surgery, pa rticipated in a sem- 
inar at the Greater New York Dental Meeting on 6 December 1963. The seminar 
was titled, "Geriatric Considerations in Dentistry. " CAPT Gerry's topic was, 
"Immediate Denture Service for the Elderly and Chronically 111. " 

(Medical News Letter 42{11):23) 

Presentation Of Navy Dental Film To Local Dental Society . CDR J. D. Shaw, 
DC, USN, presented the Navy Training Film entitled, "Endodontics," along 
with a talk before the Washoe County Dental Society at their recent meeting 
in Reno, Nevada. 

CDR Shaw is the Dental Officer at NAAS, Fallon, Nevada. 

Table Clinics At Charleston Dental Society . Navy Dental Officers of the 
Charleston, South Carolina area hosted a meeting of the Charleston Dental 
Society on 28 January 1964. CAPT William Seidel, DC, USN, SIXTH Naval 
District Dental Officer, was the Program Chairman. The following table 
clinics were presented: 

CAPT W. D. King, DC, USN "Compound Reinforced Alginate 
Naval Station Impressions" 

CAPT A. P. Giammusso, DC, "Helpful Hints in Surgical 
USN Management" 



<i 



LT P. F. Regan, DC, USNR 

Naval Hospital 
LCDR C. G, Strange, DC, "Characterization of Anterior 

USN Acrylic Bridgework" 

Naval Station 
LT L. J. Bain, Jr. , DC, USNR "The Amalgam Pin Technique" 

LT F. J. O'Bosky, DC, USNR 

Naval Station 



26 Medical News Letter, Vol. 43, No. 6 

Bay Area Armed Forces Dental Study Group Meeting . The Dental Depart- 
ment at Mare Island Naval Shipyard, Vallejo, California, headed by CAPT 
R. D. Koepke, recently served as host for the monthly meeting of the Bay 
Area Armed Forces Dental Study Group, held on February 11. 

A group of 60 dental officers from Army, Navy, Air Force, Coast 
Guard, and Public Health Service dental facilities in the San Francisco Bay 
Area assembled at the Officers' Club at Mare Island Naval Shipyard to hear 
a presentation by CAPT M. A. Mazzarella, DC, USN, who is currently on 
duty at the Naval Medical Research Unit, University of California, Berkeley, 
California. His topic was "The Relationship of Oral Environment to Dental 
Caries" - with studies conducted in Egypt (Oral Survey of Siwa Oasis). Ac- 
companying his presentation, a complete selection of color slides was uti- 
lized to illustrate the environmental conditions existing at the Siwa Oasis in 
Egypt. The lecture gave the Dental Officers of the Armed Forces an insight 
into the areas of dental research conducted by the Navy Dental Corps. 

NAS Willow Grove Hosts Local Dental Society . The Dental Department of 
the Naval Air Station, Willow Grove, Pennsylvania, acted as host at a dinner 
and meeting of the Montgomery-Bucks Dental Society (a component of the 
Pennsylvania State Dental Society), on January 27, 1964. A total of 170 civil- 
ian dentists from nearby communities, dental officers from U. S. Naval Den- 
tal Clinic, Philadelphia, Pennsylvania, Fort Dix, New Jersey, and McGuire 
Air Force Base, New Jersey, heard Captain John F. Bucher, DC, USN, 
present a talk on the "Role of Endodontics in Modern Dental Practice. " Cap- 
tain Bucher is Head of the Operative Dentistry Department and Endodontics 
Division of the U. S. Naval Dental School, Bethesda, Maryland. Following 
the talk, a film was presented on the use of closed chest heart massage, and 
practice in the technic performed on a mannequin. 

Dental Clinic Wins Sports Trophy . The U. S. Naval Dental Clinic, Norfolk, 
Virginia, was awarded the 1963 Naval Station Command Trophy for excel- 
lence in the Intramural Sports Program conducted by the U. S. Naval Station. 
The presentation was made in the Naval Station Gymnasium to Rear Admiral 
E. G. F. Pollard, DC, USN, Commanding Officer, U. S. Naval Dental Clin- 
ic, by Captain J. D. Ferguson, USN, Commanding Officer, U. S. Naval 
Station. 

It Happens To Civilians Too . A corporation recently discharged an employee 
for "off duty" misconduct, the case was appealed in court. The employee 
was a field representative for the company and was involved in two auto ac- 
cidents within two weeks during other than working hours. Police reports 
in both cases showed the employee had been speeding and had "liquor on his 
breath. " He protested that the matter was entirely his own problem since 
the incident in no way involved the company. Not so, the company replied, 
the reputation of the company and the rest of its employees was jeopardized 
by employee misconduct on or off the job. 



Medical News Letter, Vol. 43, No. 6 27 

The arbitrator ruled; "the company has no right to regulate or control 
the private lives of its employees. However, this general rule is subject to 
an exception. Where the off-the -job conduct of an employee adversely affects 
the interests or reputation of the company, such conduct may properly be pro- 
hibited. There is no doubt that the company has a right to protection against 
such damage to its reputation. Management has a right to expect employees 
-- who are temporarily stationed away from their home plants and are in contact 
with persons who know them to be representatives of the company -- to conduct 
themselves with a greater degree of propriety than would be necessary 
in their normal working environment. The discharge of the employee was 
justified. " 

This arbitration re-emphasizes a principle that is fast becoming 
common law. No man is an island unto himself. 

For Those Who Can't Brush After Eating . At the Keflavik Naval Station, 
Iceland, CAPT G. R. Reynolds has initiated a simple practice in support of 
sound preventive dentistry. Nine hundred box lunches are prepared each week 
for flight personnel. The flights are for 12 to 14 hours, and facilities for oral 
hygiene during that period are limited. To stimulate the best possible oral 
health under these conditions, pertinent reminders are inserted with the lunches, 
such as: eat the coarse foods last to take advantage of their tooth-cleansing ac- 
tion, and rinse your mouth thoroughly after eating. This is an excellent ex- 
ample of delivering the message to personnel at the most opportune time. 

$ sfe if $ sjt ^s 




OCCUPATIONAL MEDICINE 



Hazards from Thermodecomposition of Epoxy Resins 

K. J. Leong, MA and H. N. MacFarland, PhD, Ottawa, Ont. , 
Canada, Archives of Environmental Health, 7(6):6l-67, Dec. 1963. 

Introduction 

Epoxy resins are among the most versatile of modern plastics. They 
have been employed extensively in industry for surface coatings, high-strength 
adhesives, durable laminates, cold solders, and lightweight foams. Several 
types of the higher molecular weight epoxies have found application in the pot- 
ting, encapsulating, and sealing of electrical equipment, particularly electric 



28 



Medical News Letter, Vol. 43, No, 6 



motors. Here their high chemical resistance, bond strength, and mechanical 
and electrical properties can be used to advantage, especially in severe en- 
vironments. However, with potted electrical equipment, the danger of pyrolysis 
of the plastic through overheating or its combustion in open fires is always 
present. In certain military situations, several motors ranging from fractional 
horsepower to the 10- to 100-horsepower size range may be found ope rating in 
relatively confined spaces. The thermodecomposition of epoxy resins may 
produce an inhalation hazard to personnel working in such areas. 

The epoxy resins are polyethers prepared by the interaction of 
epichlorhydrin with a dihydroxy compound such as bis- (4-hydroxuphenyl)- 
dimethylm ethane (Bispnenol A). The reactive unsaturated epoxide rings permit 
polymerization reactions in the presence of various curing agents to form 
molecules of high molecular weight. The uncured thermoplastic resins are 
thus transformed readily into tough, hard, thermosetting solids. Depending 
on the type of resin desired, the curing agent may be a polyamine, a phenolic 
resin, or an acid anhydride. The irritant properties, to the skin, eyes, 
and respiratory tract, of the uncured epoxy resins, their components, and of 
the curing agents also have been attributed to the volatility and causticity of 
epichlorhydrin, the phenolic compound, or the strongly alkaline amines. 
These materials have been shown to be dermatitis agents and potent sensitizers. 
Systemic intoxication from these starting materials and uncured resins has 
been reported. The cured resins are generally regarded as innocuous, al- 
though machining operations may produce a fine dust or small amount of vapor 
that may affect a sensitized person. Direct studies to evaluate the inhalation 
toxicity of either the pyrolysis or combustion products of cured epoxy resins 
have not been found in the literature. 

The present report described experiments in which rats have been 
exposed under static conditions to both the pyrolysis and the combustion 
products of a cured epoxy resin of the type commonly used for potting the 
windings of electric motors. In the dose ranges examined, only the pyrolysis 
products proved to be lethal, and estimates of the L(Ct)50 and mean survival 
time have been computed for these products. A description has been provided 
of the characteristic types of damage produced in the respiratory tract. In 
addition, microscopic examination of kedney and liver tissue from representa- 
tive animals has permitted assessment of systemic toxic effects. The findings 
have been discussed in terms of the potential human hazard to be associated 
with the inhalation of these thermodecomposition products. 



Results 



Observations of Behavior of Animals The immediate response of 

rats exposed to the pyrolysis products of the epoxy resin was holding of the 
breath, with other indications of respiratory irritation. The signs of ir- 
ritation soon subsided, and the animals crouched quietly. As the exposure 
continued, respiration became progressively more labored, and wheezing could 
be heard when the rats were removed from the chamber at the end of the hour. 



Medical News Letter, Vol. 43, No. 6 29 

These signs persisted until death supervened. The combustion products of 
the plastic appeared to be much less irritating. The rats remained quiet 
throughout the exposure period and exhibited minimum signs of respiratory 
distress. On removal from the chamber at the termination of the exposure, 
normal behavior and activity were quickly resumed. 

Dosage -Mortality Results. In pyrolysis studies with the epoxy re- 
sin, two sets of four trials each were performed. Sample weights in the first 
set were 1. 0, 1. 4, 2. 0, and 2. 9 gm; and in the second set, 4. 2, 6. 0, 10. 5, 
and 16. gm. It will be noted that a fairly constant fraction of the resin, a'- 
bout 72%-75% in most cases, disappeared as volatile pyrolysis products which 
formed dense grayish-white fumes throughout the chamber. The temperature 
rise varied from 4-11 F above room temperature, depending on the size of the 
sample. No deaths were observed during the one hour exposure period with 
any sample. However, with the largest sample, 16 gm, the first animal died 
approximately one hour after removal from the chamber, and all the rats in 
this group were dead after four hours. The rate of dying was slower and 
deaths were more evenly distributed with the smaller sample weights. No 
deaths occurred in the group exposed to the pyrolysis products from the small- 
est sample, 1.0 gm. In the case of the remaining groups (sample weights 
from 1. 4 to 16. gm), no deaths occurred after the third day up to the tenth day 
when observations were terminated. 

Only one sample weight, 20 gm, was tested in combustion trials with 
the epoxy resin, but the experiment was repeated. Approximately 65% of each 
sample was consumed when burnt, yielding a quantity of thermodecomposition 
products slightly greater than that produced when 16 gm of the resin was pyro- 
lyzed. All animals survived throughout the exposure and during the observa- 
tion period. A mean rise of 39 F over room temperature was recorded in the 
combustion trials. 

Comment 

The experiments described above have demonstrated that sufficiently 
high concentrations of the pyrolysis products of epoxy resin are lethal to rats 
when inhaled. The data permits computation of the L (Ct) 50 of these pyroly- 
sis products, and, by using the cumulative totals at 72 hours and the method 
of probit analysis, an estimate of 3. 2 X 10 5 mg min/cu meter is obtained.lt 
is also possible, after making some simplifying assumptions, to derive the 
mean surival time of rats exposed to the computed L (Ct) 50; a value of approx- 
imately 50 hours is found. It is of interest to compare these calculated values 
with those reported in analogous studies with the pyrolysis products of poly- 
urethane foam and a polyurethane-coated nylon fabric. An L, (Ct) 50 of 2 X 
10 mg min/cu meter was derived for these polyurethane plastics; therefore, 
their pyrolysis products are only about one sixth as toxic as those produced 
by the epoxy resin. Another point of difference in the behavior of animals 
exposed to these various pyrolysis products should also be noted. With the 
polyurethane plastics, most of the deaths occurred during the 60-minute ex- 



30 Medical News Letter, Vol. 43, No. 6 

posure period, and, in fact, only a few deaths were recorded during the sub- 
sequent observations period. This mean time to death in rats exposed to the 
L (Ct) 50 was of the order of 30 minutes. This may be contrasted with the 
value of 50 hours given for the mean time of death of rats exposed to an L (Ct) 
50 of the pyrolysis products of epoxy resin. 

The histological examination of lung tissues from rats that died alter 
exposure to the epoxy re sin pyrolysis products indicated that the primary cause 
of death was respiratory failure resulting from pulmonary edema. However, 
respiratory embarrassment may also have been a consequence of histotoxic 
anoxia, since it was observed that some animals died after exposure to low 
concentrations of the pyrolysis products and exhibited a negligible degree of 
edema It is also possible that systemic toxic effects of cardiac, renal, or 
hepatic origin may have constituted a contributing factor. The role of exces- 
sive heat stress and depletion of oxygen is considered to have exerted no sig- 
nificant effect in causing mortality in the pyrolysis experiments for reasons 
which have been advanced previously. Microscopic examination of the res- 
piratory passages of rats sacrificed after exposure to the combustion products 
of the epoxy resin revealed no pathological change; phagocytic removal oi 
foreign particles appeared to be proceeding normally. 

The value of 3. 2 X 10 5 mg min/cu meter, derived for the L (Ct) 50 of 
the epoxy resin pyrolysis products, provides a basis for evaluating the hazard 
these products may present to the human. It will be assumed that man is at 
least as susceptible as rats to the action of these materials. The calculations 
suggest that a man confined in a room of 1, 500 cu ft volume for one hour with 
no appreciable air change would receive a lethal inhalation exposure from the 
pyrolysis products derived from one pound of epoxy resin. The occurrence 
of such circumstances in practice is by no means impossible to envisage. 
Furthermore, the insidious nature of the action of these products, reminis- 
cent of the action of primary lung irritants, strongly suggests that adequate 
precautions be taken either to prevent their formation or to protect exposed 
personnel. However, in overt fires where combustion of the plastic with 
flames occurs, the hazard would appear to be greatly reduced, as was con- 
cluded in the case of the combustion products of polyurethane plastics. 

Summary 

The toxicity of the pyrolysis products of an epoxy resin to rats has 
been determined. A value of 3. 2 X 10* mg min/cu meter has been estimated 
for the L (Ct) 50 when the exposure period was one hour. The mean survival 
time in rats exposed to this dose has been calculated to be approximately 50 
hours. No deaths were observed when rats were exposed to slightly higher 
concentrations of the combustion products of the resin. 

Histological sections of lungs, kidney, and liver from representative 
animals have been examined. It was concluded that respiratory failure from 
pulmonary edema was the predominant cause of death, although other effects, 
such as histotoxic anoxia and systemic renal or hepatic changes, may have 



Medical News Letter, Vol. 43, No. 6 31 

played a contributory role. No pathological damage was associated with ex- 
posure to equivalent doses of the combustion products of the epoxy resin. 

It was concluded that the pyrolysis products may constitute a hazard 
to human personnel in circumstances realizable in practice. 

* >'fi # 5j= % # 

Preplacement Examinations i n Industry 
Having a Pulmonary Health Hazar d 

J. W. G. Hannon, MD, Medical Director, Mclntyre Research 
Foundation, Washington, Pennsylvania, Industrial Medicine & 
Surgery, 33(2): 62-64, February, 1964. 

The preplacement medical examination in those industries having a potential 
pulmonary hazard has not received the serious consideration that it deserves 
in all plants and industries. This type of examination which usually consists 
of multiple phases has as its objectives the discovery of anatomic, pathologic, 
and physiologic factors which may contribute to an adverse effect if the ap- 
plicant is subsequently exposed to hazardous fumes, mists, and dusts. 

The initial medical examination should be as broad in scope as needed 
for each specific exposure, but at no time should the results of this examina- 
tion be so interpreted as to represent a safety factor that may lead to laxity 
in the control of any aerial pollutants that may exist in the working atmosphere. 
Medical control and atmospheric control are not substitutes for each other, 
but should augment each other. 

The scope of the examination may vary from industry to industry but 
its perfection is somewhat dependent upon the number of tests and studies 
employed, bearing in mind that the quality of the studies is often more im- 
portant than the quantity. The severity and type of exposure is a factor in 
determining the completeness of the examination. 

The following should be considered in the preplacement medical ex- 
amination: 

1. Occupational History 

2. Past Medical History 

3. Complete Physical Examination 

4. Chest X-Ray 

5. Lung Function Studies 

6. Special Studies. 

Occupational His tory 

The occupational history should be as complete as possible and should 
start with a notation of the birth date and subsequent activities in chronolog- 
ical order. The records of full time industrial jobs should be made, indicat- 
ing the type of industry, the kind of job held, and the duration of employment. 



32 Medical News Letter, Vol. 43, No. 6 

This portion of the history should also include mention of hobbies and part- 
time jobs in the adolescent and following years. Pulmonary, anatomic, and 
physiologic damage can and sometimes does occur as a result of short exposures 
to high concentrations of fine dusts produced by the grinding of products 
containing silicon dioxides. Amateur ceramic workers may develop mild 
fibrotic lung changes. Experimentation with electrical units which produce 
concentrations of ozone may cause physiologic damage to the lungs. The 
trend of some teenagers to sniff the odors of various chemicals presents a 
potential danger. The sniffing of scouring powders has been known to produce 
a serious type of silicosis. 

Efforts should be made to evaluate any prior exposure to pulmonary 
hazards. In the case of prior exposure to silicon dioxide, itmustbe realized 
that silicosis is a progressive disease and lung lesions which maybe absent 
on the initial x-ray examination may appear on the chest x-ray at a later date 
and without further exposure to this compound. Exposure to high concentra- 
tions of the so-called inert dusts may lead to the precocious development of 
silicosis when the applicant is subsequently exposed to this compound Every 
effort should be made to determine if prior exposures may have an adverse 
effect on the applicant if hired. 

Past Medical History 

The past medical history is important in determining if any health fac- 
tor is present that may impair the physical integrity of the applicant in the 
near future, especially if he is exposed to certain aerial contaminants. 

Particular attention shouldbe given to tuberculosis in the applicant ana 
his immediate family, and to chronic or recurrent bronchitis, allergies, 
pneumonia or pneumonitis, particularly if recurrent. A history of anemia, 
rheumatic fever with cardiac involvement, and renal disease should receive 
consideration. Chronic systemic diseases should be well evaluated. Ahistory 
of exertional dyspnea is of great significance and should be carefully eval- 
uated The physical examination should be complete with special attention to 
the cardiorespiratory systems. The hearing, vision, reflexes and overall 
intelligence and attitude are very important as many operations producing 
pulmonary hazards are dangerous. Also, many have been changed by techni- 
cal advances and must, ofnecessity, be manned by keen and alert personnel. 

Special attention should be directed toward mouth breathers who do 
not have the protection of the filtering system of the nose and hence allow a 
high percentage of aerial dusts to enter the trachea and lungs. In addition, 
the mouth breather has a higher incidence of lower respiratory infections. 

The examination of the thorax should determine the presence or absence 
of physical signs in the lungs or heart which might predispose the applicant 
to greater than normal retention of inhaled foreign material. 

The examination of the thorax should also include observation of the 
amplitude of chest wall excursions during normal and forced breathing. 
Forced ventilation can cause the appearance of abnormal breath sounds not 



Medical News Letter, Vol. 43, No. 6 33 

found during normal breathing. 

The examination of the abdomen should be thorough to determine the 
presence or absence of pre-existing disease. 

The record should also include notations of the height, weight, tem- 
perature, blood pressure, as well as examinations of the skeletal system, 
the joints, and the inguinal region for the presence of hernias. 

X-ray Examination 

The x-ray examination of the chest should be made with proper tech- 
niques so that a film of good quality and density is produced. The x-ray film 
should be used to help screen out those applicants who, through one or more 
conditions, may be poor risks in a job where there is a pulmonary hazard. 

Reasons for rejections on the basis of an x-ray film alone are as 
follows: 

1. Evidence of a pneumoconiosis 

2. Pneumonitis 

3. Active infection, localized or generalized 

4. Extensive healed infection, i.e., tuberculosis, histoplasmosis, 
sarcoid, fungi 

5. Extensive bullous emphysema 

6. Significant cardiac enlargement 

7. Aneurysm of the aorta 

8. Post-thoracotomy scars and associated pleural reaction 

9. Tumors, benign or malignant 

10. Diffuse lung shadows regardless of their etiology. 

Lung Function Studies 

It is a well recognized fact that incipient, or an insidious, progressive 
pulmonary dysfunction cannot always be recognized during the physical 
examination or on the x-ray film, but can be found through the use of lung 
function tests. As a result of much study, certain tests of proved value which 
fulfill the requirements in industry have been developed and used over a 
significant number of years. These tests are simple innature, easily performed, 
not time consuming, and have a reasonable scientific accuracy. The tests 
can be performed by using a Douglas bag and expressing the expired air 
through a gas meter for measurement or by using a special Lee adapted gas 
meter with a counting mechanism to determine the number of respirations 
during the test and, of course, the use of its usual measuring devices. 

The methods that have been in use involve the following measurements: 
vital capacity, maximum breathing capacity, maximum tidal volume, pulmo- 
nary reserve, and functional pulmonary reserve. 

Vital capacity tests are carried out in the usual manner and three read- 
ings are made. The highest reading is accepted as the value for the subject 
studied. In our experience with the vital capacity tests, we find that it 



34 Medical News Letter, Vol. 43, No. 6 

is not expecially valuable when single tests are made; but, where yearly es- 
timations are carried out comparative studies obtained on each examination 

are of great value. 

Normal tidal volumes are measured by having the subject seated at 
rest and collecting all of his expired air for a period of seven minutes. The 
air is measured and divided by the number of respirations, giving the normal 
tidal volume or resting oxygen requirements. In other words, the subject 
must take in so many cc's of air per breath at rest in order to satisfy his body 
oxygen requirements. 

Maximum breathing capacity and maximum tidal volume are measured 
by having the subject stand and breathe as forcibly as he can for a 20 second 
period at a respiratory rate of 60 times per minute. The air is collected or 
measured in a Douglas bag, gas meter, or spirometer. The air is measured 
and the volume is interpreted as maximum breathing capacity. The volume 
of air divided by the number of respirations is the maximum tidal volume. 

Pulmonary reserve is the difference between the normal tidal volume 
and the maximum tidal volume. This amount of air represents the reserve 
ventilating capacity available to the individual when carrying on activities that 
place a demand on the lungs for more oxygen. 

Functional pulmonary reserve is measured by taking 60% of the ob- 
served pulmonary reserve and adding the normal tidal volume. 

These tests have been carried out over a period of 16 years, and ap- 
proximately 40, 000 tests have been performed on men who are either in the 
status of applicants or in yearly studies of the pulmonary function. The tests 
correlate well with the symptomatic history, the industrial history, the phys- 
ical examination, and the x-ray. As a word of warning, all lung function tests 
are greatly modified by the presence of an acute bronchitis or tracheolaryn- 
gitis A reduction by as much as 50% in the pulmonary function can be ex- 
pected during the period of the infection, and a lesser amount of measurable 
impairment will last for two or three weeks after the workman has become 
asymptomatic. 

Special Tests 

Special tests are optional and may be of a specific nature for a par- 
ticular industry, or may be indicated as a result of questionable findings 
during the history, physical examination, x-ray film examinations, or the 
lung function tests. For instance, skin testing may be done to determine the 
degree of allergy to the exposure material. Other examples of special tests 
are the employment of the electrocardiogram in applicants with suspicious 
heart disease, and routine blood chemistry where indicated. 

S ummary 

The preplacement medical examination in industries having a pulmo- 
nary hazard is an important factor in the prevention of industrial lung disease. 



Medical News Letter, Vol. 43, No. 6 35 

The scope of the examination must be determined by the severity and type of 
the hazard, the economics of the industry, and other factors that may be of 
an uncontrollable nature. 

* * * # $ # 
Requirements for Heat Protective Clothing Discussed 

Industrial Hygiene News Report published by Flournoy & Associates, 
1791 Howard Street, Chicago 26, 111., VI(11):3, Nov. 1963. 

Technical methods for fashioning heat protective garments were outlined by 
B. Metz of the Laboratory of Applied Physiology, Faculty of Medicine, Stras- 
bourg, France, at the XlVth International Congress on Occupational Health 
in Madrid, September 16 to 21. The methods were discussed in terms of the 
functions performed: 

L To hinder the entry of ambient heat : An aluminum coating of the 
outer surface of the garment that will neither tarnish nor get dirty is necessary 
for it to maximally reflect radiant heat. Overcoats of polished metal platelets 
similar to coats of mail were proposed to be worn over ordinary insulated 
garments to avoid some inconveniences of garments made of metal-coated 
fabrics. Insulation of the garment may be through a lining of carded cotton, 
glass wool or foamed plastic to decrease the heat flow from the outer to the 
inner face of the garment. Dynamic insulation in which the air flows outwards 
through the whole covering area of the garment will reject the heat gained by 
the outer face of the garment. By wetting the shell of the garment, either 
prior to exposure to heat or during, the heat gained by the garment will be 
lost by evaporation of water toward the ambient air. 

2. To get rid of the heat entering or produced within the garment : Air 
cooled by conventional refrigerating machinery, evaporative cooler or vortex 
cooler, may be blown inside the garment. The heat that has entered the 
garment maybe absorbed by means of a "heat sink, »' consisting of cold water 
circulated from the outside, eutectic mixture previously frozen at a point 
below its melting plateau, or thermo-electric heat pump applying the Peltier 
effect. Whichever process is involved, itis necessary to provide for internal 
circulation of the air enclosedbetween the body and the garment and to provide 
for some renewal of this air to keep the CO z concentration below 2%. 

3 - To avoid heat damage to the garment : The garment should be made 
of materials which will remain unaltered at the temperature of their regular 
use and which will also be fireproof, in case of back-fires or splashing of 
molten metal. 

4. To maintain efficiency of the worker wearing the garment : A metal 
coating of the plastic or glass window with which the aperture for vision is 
fitted will reduce the radiant heat load to the face. Gloves should have enough 
insulation to permit the handling of hot objects with manipulatory freedom. 
The soles of shoes or boots should be sufficiently insulated so that the foot 



36 



Medical News Letter, Vol. 43, No. 6 



withstand contact with a hot floor, and skin temperature not exceed 40° C 



( 104° F ). 



****** 

C arbon Monoxide Hazard to Commercial 
Vehicle Drivers Studied 

Industrial Hygiene News Report, VI (10): Oct. 1963. Consultant 
Editor Howard N. Schulz, published by Flournoy and Associates, 
1791 Howard Street, Chicago 26, 111. 

Are the concentrations of ambient carbon monoxide to which commerical ve- 
hicle drivers are exposed in the course of a day's work sufficient to constitute 
a hazard? A report on the subject was presented at the XlVth International 
Congress on Occupational Health in Madrid, September 16 to 21, by Warren 
A Cook, Professor of Industrial Health, University of Michigan (Ann Arbor, 
Mich. ). Mr. Cook was one of eight university faculty members sponsoredby 
the U. S. Delegation of the International Association on Occupational Health. 
Among salient points included in his presentation were these: 

1. It would appear that the threshold value of CO-hemoglobin saturation 
necessary to cause increased accident susceptibility would be no less than 
15% and no more than 20% depending on the criteria employed and interpreta- 
tion of criteria. 

2. A 20% CO-hemoglobin saturation would occur on continued exposure to 

a concentration of 160 ppm and 15% on exposure to 110 ppm. 

3 Blood samples taken at 2 hour intervals from two persons in a police 
car being driven around in high traffic areas of the city over an 8 hour day 
all indicated less than 4% CO-hemoglobin saturation. CO concentrations in- 
side the car averaged 17 ppm with a peak of 120 ppm when the car was stopped 
and the engine idling. Blood samples of one of the two subjects who was a 
non-smoker ranged from 0. 8 to 1. 2% CO-hemoglobin saturation while those 

of the other who smoked cigars most of the test period ranged from 3. 1 to 3. 9%. 

4 With only one exception, the blood analyses of 227 persons involved in 
traffic accidents in the Detroit area showed less than 12% CO-hemoglobin sat- 
uration. The single exception was attributed to a leaky exhaust system. 

5. Carbon monoxide concentrations obtained from three locations in De- 
troit over a period of a year, by means of continuous -recording non-disper- 
sing infrared spectrophotometers, showed that commerical vehicle drivers 
would be subjected to a 9 hour exposure to ambient CO concentrations which 
would range from 12 to 25 ppm during the first hour and a half of each day, 
then fall to 10-18 ppm during most of the day and rise to 17 to 32 ppm over the 

last hour and a half. . 

Based on these data, it was concluded that present traffic conditions 
in Detroit produce insufficient carbon monoxide to constitute a hazard either 
to health or to driving ability; however, statistical treatment of the findings 



Medical News Letter, Vol. 43, No. 6 



37 



indicated that a combination of increased traffic load together withmeteorolog. 
ical conditions favoring accumulations of exhaust gas may result in excessive 
concentrations of carbon monoxide. 



****** 



Cases of Human Anthrax,* 1953 - 1963 

Morbidity and Mortality Weekly Report, DHEW-PHS, 13(8): 62, 
Feb. 28, 1962. 

Number 
of Cases 
50. 




Reported to: NOVS and CDC 



Anthrax Surveillance Summary - 1963 

Three cases of human anthrax were reported during 1963. This figure repre- 
sents a continuation of the downward trend of this disease to its lowest point 
since reporting began. The above histogram depicts the pattern of human an- 
thrax occurrence over the last 11 years. The decline in cases is probably 
related to several factors including the use of the anthrax cell-free vaccine in 
high risk industrial populations, continued improvements in industrial hygiene, 
and the decreasing imports of animal products associated with Bacillus an- 
thracis contamination. " 



38 Medical News Letter, Vol. 43, No. 6 

Females comprised the 3 cases occurring in 1963. All had industrial 
contact with the organism; 2 worked with goat hair and one with wool. All 
cases were of the cutaneous type, diagnosed clinically without laboratory con- 
firmation; there were no fatalities. None of the patients had been immunized 
with the cell-free anthrax vaccine at the time of infection. One of the 2 goat 
hair associated cases occurred in a new employee, who had not been immu- 
nized during the 2 weeks of her employment. The other 2 cases occurred in 
individuals working in plants whose employees were not immunized. (Limited 
supplies of the vaccine are available for selected high-risk groups upon 

request from the CDC. ) 

This is only the second year since 1916 whenno agriculturally associated 
cases have been reported. A similar situation occurred in 1961 when all 9 
cases of human anthrax were industrially associated. 

The only significant animal outbreak of anthrax reported in 1963 occurred 
among deer in Arkansas. This outbreak resulted in approximately 400 deaths, 
a loss of 70 to 90 percent of the deer population in the involved area. 

(Reported by Anthrax Investigations Unit, CDC. ) 



$ if # >1= 




RESERVE ]jjp^ SECTION 

A CDUTRA Pay Speeded — If You Follow Rules 

The Naval Reservist, NAVPERS 15653, March 1964. 

It won't be long, now, before the an annual ACDUTRA rush is on. You will 
speed payment of your ACDUTRA pay and allowances if you follow these sug- 
gestions : 

Copies of Orders — Reservists sometimes lack the proper number of 
certified copies of orders, or have incomplete orders. 

All Reservists are required to have the original and eight certified, 
copies of orders in their possession, complete with all endorsements, in- 
cluding the signature of the Reservist acknowledging receipt of orders, when 
reporting for ACDUTRA. 

Don't detach any of the copies of the orders you receive unless you 
have more than the minimum number required. If you submit fewer than the 
required number, the disbursing office may return the orders to you for the 
purpose of preparing additional copies yourself— or having them prepared by 

the personnel office. 

Make sure you have all necessary endorsements completed before you 

submit your set of orders to the disbursing office. 

Basic Allowance for Quarters (BAQ) — You can save yourself lots of 



Medical News Letter, Vol. 43, No. 6 39 

time if you have your substantiating documents for BAQ completed and certi- 
fied before you report for ACDUTRA. 

Officers must file Dependency Certificate — Wife, or Child Under 21 
Years, NavCompt Form 2040. In addition, the Dependency Certificate-Moth- 
er and/or Father, NavCompt Form 2040-1, is required when it is appropriate 

Enlisted Reservists must file Application for Dependents Allowances 
NavPers Form 668. 

Failure to have these forms completed and ready for submission when 
requested will hinder or delay payment of your BAQ. Whenever possible, ob- 
tarn the necessary forms from your Naval Reserve Training Center, and have 
them completed there. 



ATTENTION: Reserve Nurse Corps O ffice r s 
on inactive du ty 

This is an excellent time for you to return to active duty if you are qualified 
and interested. We have vacancies due to normal attrition and increasing 
numbers for voluntary retirements. If you hold the rank of Lieutenant Junior 
Grade or Lieutenant and could complete 20 years of active duty before reach- 
ing age 55, you may apply. Application for recall to active duty NavPers 2929 
may be obtained at the nearest naval recruiting station. 

* * # * s!= $ 

Reservists Eligible for Tax Deductions 
The Naval Reservist, NAVPERS 15653, March 1964. 

You may be eligible for additional federal income tax deductions if you've been 
taking an active part in the Naval Reserve program. 

If you are serving on inactive duty, you may deduct amounts spent for 
the purchase and maintenance of your uniforms; you may also deduct trans- 
portation expenses involved in attending drills. 

Here is a brief summary of allowable tax deductions for Reserve par- 
ticipation: 

Uniform Cost, Maintenance 

You may deduct unreimbursed amounts spent for the purchase and 
maintenance of uniforms for federal income tax purposes. Your deductions 
will vary according to whether you are on inactive duty or extended active 
duty. An Internal Revenue Service ruling states that the deduction is allowed 
as an "ordinary and necessary business expense" when uniforms are required 
and allowed to be worn only when on active duty for training for temporary 






40 



Medical News Letter, Vol. 43, No. 6 



periods, when attending service school courses, and training assemblies 

(drills). 

If you are on inactive duty, you may deduct not only the cost of uniforms 

required for training duty and drills, but the maintenance costs of these 

uniforms. However, if you receive a uniform gratuity, your expenses are 

deductible only to the extent that they exceed your uniform gratuity in that 

particular year. 

For example, you may deduct the cost— purchase price and maintenance 

— of uniforms bought in 1963, when you file your 1963 federal income tax re- 
turn. If you received a uniform gratuity of, say, $100, and the cost and main- 
tenance of your uniforms amounted to $175, you may deduct $75 on page 2 of 
your tax return {Form 1040). If you received no uniform gratuity in 1963, you 
may deduct the entire sum— in this example $175. A uniform gratuity re- 
ceived in a year is nontaxable and need not be considered, except as an offset 
against uniform expenses incurred during that same year. 

(Reservists" serving on full-time active duty may only deduct the cost 

of all items of insignia denoting rank and corps. ) 

(To be continued) 



* * * 



* 



sssNisne hvidnjo 



lN3W±lJVd3CI AAVN 
CSlVd S33 J QNV 39VlS0d 



dNVlAMVW Vl V0S3H13B 
H31N33 1VDIQ3W "IVAVN 1VNOI1VN 

-jooHos TivDiaaw ivavn "s *n 
AAVN 3H1 dO J.N3WJLHVd3a